Medicare proposes 2.6% reimbursement increase for outpatient care

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CMS has proposed a 2.6% increase in reimbursement for hospital outpatient departments for the upcoming year. This adjustment is projected to result in an additional $5.2 billion being allocated to these providers, according to a proposed payment rule released by CMS July 10.

If the rule is finalized, ambulatory surgery centers that meet specific quality standards will also see a 2.6% payment increase, amounting to approximately $202 million more in reimbursements in 2025, according to CMS.

Additionally, the new rule requires states to offer one year of continuous eligibility in Medicaid and the Children’s Health Insurance Plan for children under 19. This move aims to enforce a requirement from the 2022 spending legislation, which has faced resistance from some Republican states. For the first time, the rule also sets baseline safety requirements for hospitals’ obstetric services.

The proposed 2.6% bump for outpatient centers and ASCs matches the increase CMS suggested for hospital inpatient departments in April.

The proposed rule also introduces new standards for obstetrical services in hospitals participating in Medicare, aiming to address the U.S.’s poor maternal health outcomes.

The new standards require hospitals to implement maternal quality assessments, performance improvement plans, and reporting of maternal health data. Hospitals failing to meet these standards risk losing their Medicare certification.

The rule proposes reducing the timeframe for Medicare to complete prior authorization requests for outpatient services from 10 days to seven, aligning with the standards for other insurers, including Medicare Advantage plans.

CMS is also seeking to simplify Medicare enrollment for eligible previously incarcerated individuals and enhance equity measures in quality assessment programs for outpatient centers, ASCs, and rural emergency hospitals.